CHF患者cAMP cGMP和NE ANF的变化及临床意义

通过放免法和高压液相色谱－电化学法，测定了９２例充血性心力衰竭（ＣＨＦ）患者血浆环核苷酸（ｃＡＭＰ、ｃＧＭＰ）、心钠素（ＡＮＦ）和去甲肾上腺素（ＮＥ）水平。结果表明：血浆ｃＡＭＰ、ｃＧＭＰ和ＡＮＦ、ＮＥ浓度随着心衰程度加重而显著增加，ｃＡＭＰ／ｃＧＭＰ比值下降，与病因无关；心衰纠正后，上述指标明显恢复。血浆ｃＡＭＰ、ｃＧＭＰ与ＮＥ、ＡＮＦ水平显著相关。提示：血浆环核苷酸浓度同ＮＥ、ＡＮＦ一样，可作为评价ＣＨＦ患者心功能和观察疗效的一种生化指标。     

Serum α_1-acid glycoprotein,sialic acid,and protein binding of disopyramide in normal subjects and cardiac patients

目的：研究日本人充血性心力衰竭（ＣＨＦ）和急性心肌梗塞（ＡＭＩ）病人对血清α１酸性糖蛋白（ＡＧＰ）、唾液酸（ＳＡ）浓度及ＡＧＰ与丙吡胺（Ｄｉｓ）结合的影响．方法：对正常人、ＣＨＦ及ＡＭＩ患者血清样本９７例，采用免疫化学法测定ＡＧＰ浓度，高效液相层析法测定ＳＡ浓度及超滤膜技术和高效液相层析法测定Ｄｉｓ的体外游离浓度．结果：ＣＨＦ及ＡＭＩ患者血清ＡＧＰ浓度较正常人升高．Ｄｉｓ药物游离浓度降低．血清ＳＡ浓度的变化与血清ＡＧＰ浓度的变化趋势一致．结论：ＣＨＦ和ＡＭＩ病人血清药物游离浓度受血清ＡＧＰ结合的影响而变化，应进行临床监测．     

138例冠心病患者血浆肾素活性及血管紧张素Ⅱ水平的观察

采用放免法检测了不同类型的１３８例ＣＡＤ患者血浆ＰＲＡ及ＡＴⅡ水平，其中ＡＭＩ患者４７例，ＵＡＰ患者２３例，ＯＭＩ患者３１例，ＳＡＰ患者３７例，并将其与２６例正常人测得值进行比较。提示：ＣＡＤ时ＲＡＳ活性显著增强，参与了ＣＡＤ的病理过程。     

充血性心力衰竭患者血浆肾上腺髓质素水平观察

研究充血性心力衰竭（ＣＨＦ）患者在不同心功能状态下及治疗前后血浆肾上腺髓质素（ＡＭ）含量,同时分析其与内皮素（ＥＴ）和血管紧张素 Ⅱ（Ａｎｇ Ⅱ）含量之间的关系。用放射免疫法测定了 ５１例 ＣＨＦ患者和 ３０例对照组的血浆 ＡＭ、ＥＴ和 Ａｎｇ Ⅱ含量。结果发现,ＣＨＦ组不同程度的心功能患者血浆 ＡＭ、ＥＴ、Ａｎｇ Ⅱ含量均较对照组明显增高（Ｐ＜０．０１）,且血浆 ＡＭ、ＥＴ、Ａｎｇ Ⅱ含量随心功能恶化而升高,随心功能改善而下降,但仍高于对照组（Ｐ＜０．０１）。ＣＨＦ ,患者治疗前后血浆ＡＭ与ＥＴ、Ａｎｇ Ⅱ含量均呈显著正相关。提示血浆ＡＭ升高可能与ＥＴ和Ａｎｇ Ⅱ含量升高有关,可反映心力衰竭严重程度和作为判断疗效的一项指标。     

DDD及VVI起搏时血浆儿茶酚胺,肾素,血管紧张素,醛固酮,心钠素水平变…

采用高效液相或放免法检测３１例安置ＤＤＤ或ＶＶＩ起搏器病人术前及术后１周静息时血浆儿茶酚胺，肾素，血管紧张素ＩＩ，醛固酮及心钠素浓度。结果显示：８例ＤＤＤ起搏者，起搏前后血浆ＣＡ，ＰＲＡ，ＡＩＩ，Ａｌｄ，ＡＮＰ水平均无明显变化。     

动物肝脏RNA的生产工艺改进

动物肝脏ＲＮＡ的生产工艺改进ＩＭＰＲＯＶＥＤＰＲＯＣＥＤＵＲＥＦＯＲＰＲＯＤＵＣＴＩＯＮＯＦＲＮＡＦＲＯＭＡＮＩＭＡＬＬＩＶＥＲ杨开荣邵罡ａ＊（南京第三制药厂，江苏２１０００８；ａ南京生物化学制药厂，江苏２１００１５）ＹＡＮＧＫａｉ－Ｒｏｎｇ，ＳＨＡ...     

心衰患者内皮素与肾素-血管紧张素-醛固酮系统(RAAS)的关系

采用放免分析法测定了５３例慢性充血性心力衰竭（ＣＨＦ）患者及１９例正常对照者血浆内皮素（ＥＴ）、血浆肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡⅡ）和醛固酮（ＡＬＤＯ）值，结果显示：ＣＨＦ心功能Ⅱ级患者ＡⅡ高于对照组（Ｐ＜０．０５）。严重心衰（心功能Ⅲ、Ⅳ级）患者ＥＴ、ＡⅡ、ＡＬＤＯ均明显高于心功能Ⅱ级和对照组（均Ｐ＜０．０１）；ＡⅡ高于心功能Ⅱ级组和对照组（Ｐ＜０．０５）。ＥＴ与ＰＲＡ呈正相关。表明ＣＨＦ患者ＥＴ与肾素－血管紧张素－醛固酮系统的变化是一致的，二者可能存在相互促进的调节作用。     

心力衰竭患者心率变异性与室性心律失常心功能的关系

用２４小时动态心电图检测４５例心力衰竭（ＣＨＦ）患者，室性心律失常（ＶＡ），检出率：简单型８８．９％，复杂型５３．３％。短阵室速３１．１％。高级别ＶＡ多见于ＥＦ值低患者。测定３１例窦性心律患者的心率变异指数（ＨＲＶＩ），并设立正常人３３例为对照组，可见ＣＨＦ时ＨＲＶＩ较正常明显减小（Ｐ＜０．００１）；ＬｏｗｎⅢ级以下ＶＡ患者ＨＲＶＩ较ＬｏｗｎⅣ～Ⅴ级者明显高（Ｐ＜０．００１）；心功能Ⅰ～Ⅱ级时ＨＲＶＩ与心功能Ⅲ级、Ⅳ级时ＨＲＶＩ相比，有显著差别（Ｐ＜０．００１）。将患者ＥＦ值与ＨＲＶＩ进行直线相关分析，两者呈正相关（ｒ＝０．５７，Ｐ＜０．０５）。本文结果示ＣＨＦ患者心率变异性小，而且ＨＲＶＩ越小者发生ＶＡ可能性大，心室功能受损明显。     

急性心肌梗塞患者血浆心钠素与肾素系统的变化及作用

检测３４例正常人及７１例急性心肌梗塞（ＡＭＩ）患者血浆心钠素（ＡＮＰ）、肾素（ＰＲＡ）、血管紧张素ＩＩ（ＡＩＩ）、醛固酮（Ａｌｄ）的含量。其中发病４８小时内入院者４２例，４８小时至１周入院者２９例。结果显示：ＡＭＩ患者血浆ＡＮＰ、ＰＲＡ及ＡＩＩ均较正常组为高（Ｐ〈０．００１），Ａｌｄ无明显变化（Ｐ〉０．０５）；发病４８小时前后比较仅ＡＩＩ有明显差异（Ｐ〈０．０５），提示在急性心肌梗塞早期，血浆中Ａ     

正常人和心脏病患者血清α1—酸性糖蛋白,唾液酸及丙吡胺蛋白…

目的：研究日本人充血性心力衰竭（ＣＨＦ）和急性心肌梗塞（ＡＭＩ）病人对血清α１－酸性糖蛋白（ＡＧＰ）、唾液酸（ＳＡ）浓度及ＡＧＰ与丙吡胺（Ｄｉｓ）结合的影响。方法：对正常人、ＣＨＦ及ＡＭＳ患者血清样本９７例，采用免疫化学法测定ＡＧＰ浓度，高效液相层析法测定ＳＡ浓度及超滤膜技术和高效液相层析法测定Ｄｉｓ的体外游离浓度。结果：ＣＨＦ及ＡＭＩ患者血清ＡＧＰ浓度较正常人升高。Ｄｉｓ药物游离浓度降低。血清Ｓ     

心力衰竭与急性心肌梗塞患者神经内分泌水平的动态比较

通过测定血浆PRA,AI、ALD、ANP及AVP浓度的变化,研究比较CHF和AMI时神经内分泌水平的动态演变。发现CHF患者神经内分泌水平显著高于AMI患者,随着临床症状改善CHF患者神经内分泌水平逐渐下降,AMI患者各项指标变化不一致,PRA及AI在住院第四天显著高于第一天和第八天的水平,ANP及AVP血浆浓度在发病第一天最高,此后逐渐下降。我们认为神经内分泌兴奋性的升高是CHF发生的主要原因,但在AMI时神经内分泌兴奋性的升高是AMI导致的结果。     

Peripheral hemodynamic and humoral effects of oral zofenopril calcium (SQ. 26,991) in patients with congestive heart failure

In 14 patients with congestive heart failure (CHF) of various grade (NYHA class 2-4) the effects of zofenopril calcium (SQ 26,991) on blood pressure and forearm circulation were studied by venous occlusion plethysmography. Changes in plasma renin activity (PRA), aldosterone, Atrial natriuretic factor (ANF) and arginine-vasopressin (AVP) were also measured. Two hours after oral administration of 7.5 mg of zofenopril we observed a decrease in blood pressure, heart rate, and forearm vascular resistance along with an increase in venous distensibility. Zofenopril also decreased ANP levels in a manner directly related to peripheral venodilatation (r = .64; P less than .05) and modified arginine-vasopressin (AVP) proportionally to the fall in blood pressure observed in response to drug administration (%SBP/%AVP: r = .64, P less than .05; %DBP/%AVP: r = .67, P less than .05). Hemodynamic and humoral responses to zofenopril occurred without any significant unwanted adverse reaction, even in patients with greater pressor reduction. We conclude that oral acute zofenopril administration, in patients with congestive heart failure, causes an arterial and venous forearm vasodilatation which is probably involved in the acute changes in plasma levels of ANF and AVP observed after drug administration.     

Intersubject variability in plasma theophylline levels after oral and intravenous administration in Jordanian patients with chronic obstructive pulmonary disease

Plasma theophylline concentrations were determined in 151 Jordanian patients with chronic obstructive pulmonary disease. Mean plasma levels after oral administration were below the therapeutic range and significantly lower than after intravenous administration. Plasma levels in patients with congestive heart failure (CHF) were higher than in patients with no CHF. Trough plasma theophylline concentrations after intravenous administration in patients less than 18 years of age were significantly lower than in those aged 18-60 years. The overall results are in agreement with observations made in other ethnic groups.     

Neurohumoral changes in patients with left ventricular dysfunction following acute myocardial infarction and the effect of nitrate therapy: a randomized, double-blind, placebo-controlled long-term study

BACKGROUND: Several neurohumoral mechanisms involved in cardiovascular regulation are activated in the failing heart, but only limited information is available regarding the influence of long-term nitrate therapy. MATERIALS AND METHODS: This was a double-blind, randomized comparison of isosorbide-5-mononitrate (IS-5-MN), 60 mg given orally, once daily for 11 months to patients (n = 47) with left ventricular (LV) dysfunction following acute myocardial infarction (AMI). Forty-five patients received placebo. All patients received ramipril.Plasma natriuretic peptides (atrial [ANP] and brain [BNP] natriuretic peptide), epinephrine, norepinephrine (NEPI), antidiuretic hormone, aldosterone (Aldo), renin activity (PRA), substance P, neuropeptide Y-like immunoreactivity, calcitonin gene-related peptide, and vasoactive intestinal peptide were measured at baseline and at the end of the treatment period. Clinical, echocardiographic, and hemodynamic data were also obtained. RESULTS AND CONCLUSIONS: Chronic nitrate therapy does not significantly affect the neurohumoral status in patients with LV dysfunction after AMI, apart from a decrease in ANP. Some hormones are more closely associated with diastolic dysfunction/increased volume load (ANP and BNP) and others are more closely associated with systolic dysfunction (PRA, NEPI, Aldo). There is a temporal dissociation of these 2 groups of hormones 1 year post infarction: ANP and BNP decrease, whereas NEPI and Aldo show a slight increase. BNP levels do not reflect all important pathophysiologic mechanisms in heart failure. Consequently, the use of other neurohormonal factors than BNP for monitoring of heart failure therapy should be explored.     

心钠素、肾素-血管紧张素-醛固酮系统在慢阻肺病、肺心病的变化及相互关系

本文应用放免法测定了正常人16例、肺气肿13例、肺心病51例血浆心钠素(ANP)、肾素活性(PRA)、血管紧张素Ⅱ(AT Ⅱ)、醛固酮(Aldo)的浓度,结果发现①肺气肿组血浆 ANP 水平明显低于正常对照组;②肺心病不同心功能血浆 ANP 水平不同,心功能Ⅰ、Ⅱ、Ⅲ级肺心病患者的血浆 ANP 浓度各组之间有明显差异;③肺心病组血浆 PRA,AT Ⅱ、Aldo 的水平明显高于肺气肿组;④血浆 ANP 与 PRA 有一定的正相关。     

老年慢性心力衰竭患者血清肌钙蛋白T及尿酸检测的临床意义

目的探讨老年慢性心力衰竭（CHF）患者血清肌钙蛋白T（cTnT）及尿酸（UA）水平检测的意义。方法回顾性分析200例老年慢性心力衰竭患者临床资料,心功能Ⅰ级为对照组,Ⅱ、Ⅲ、Ⅳ级患者为观察组,每组50例。分析血UA、cTnT与慢性心力衰竭的发生是否存在相关性。按cTnT浓度分为正常组和增高组,比较其住院期间及随访2年发生的心脏事件（心力衰竭反复或加重、死亡）的发生情况。结果观察组cTnT与UA含量明显高于对照组。cTnT增高组患者心脏事件的发生率明显高于正常组（P〈0．05）。结论心衰越重,cTnT与UA增高越明显,血尿酸、肌钙蛋白T与充血性心力衰竭密切相关,是充血性心力衰竭发病的危险因素,二者联合可作为评价老年心力衰竭严重程度的指标。cTnT对判断老年慢性心力衰竭患者的预后有较好的预测价值。     

Prolonged neutral endopeptidase inhibition in heart failure.

We studied the hormonal, renal and hemodynamic effects of prolonged treatment with SCH 39370, a new neutral endopeptidase (NEP) inhibitor, in experimental congestive heart failure (CHF). Coronary-ligated CHF rats and sham-operated controls received vehicle or SCH 39370 30 mg/kg s.c. twice daily for six days. In rats with heart failure, SCH 39370 elevated the high plasma atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) levels 2-fold both initially and at the end of the experiment. Initially, water balance was more negative in SCH 39370-treated CHF rats than in those treated with vehicle. In all SCH 39370-treated rats, ANP, cGMP and electrolyte excretion and diuresis were pronounced for 6 h after injection but attenuated thereafter. Blood pressure and pulse remained unchanged. On reverse phase high performance liquid chromatography (HPLC), ANP-(99-126) appeared to be the only circulating form of ANP in rats with heart failure. Three forms have been discovered in patients with heart failure. HPLC revealed only intact ANP in plasma of rats with heart failure during SCH 39370 treatment. NEP inhibitors may provide a new tool for treating chronic heart failure.     

Alpha 2-adrenergic stimulation and vasopressin in congestive heart failure

Patients with chronic heart failure (CHF) have increased plasma levels of the antidiuretic hormone arginine vasopressin (AVP). The stimulus for increased AVP secretion is unknown, but appears to involve a nonosmotic drive which alters normal osmoregulatory mechanisms. Centrally acting alpha 2-adrenergic agonists suppress AVP secretion in experimental animals. To examine the hypothesis that such effects might be apparent on the chronically elevated AVP levels in patients with CHF, we measured AVP, heart rate (HR), mean arterial pressure (MAP), and plasma norepinephrine (NE) after 4 mg oral guanabenz in nine patients with this disease. Plasma NE decreased from 513 +/- 131 to a minimum of 371 +/- 117 pg/ml (p less than 0.02) 5 h postdrug. HR decreased from 80 +/- 9.3 to 74 +/- 10 beats/min (p less than 0.05) and MAP decreased from 88 +/- 8.5 to 83 +/- 10 mm Hg (p less than 0.05). Plasma AVP, however, did not change from baseline levels of 5.6 +/- 1.6 pg/ml. Serum osmolality was also constant. These data do not support a possible role for acute increases of alpha 2-adrenergic activity in suppressing the increased plasma AVP levels of CHF, at least under basal conditions at constant osmolality.     

COPD合并心力衰竭患者B型钠尿肽水平的变化

目的:探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并充血性心力衰竭(congestive heart failure,CHF)患者B型钠尿肽(B-type natriuretic peptide,BNP)水平的变化及临床意义.方法:选取慢性阻塞性肺疾病急性加重期(acute exacerbation chronic obstructive pulmonary disease,AECOPD)患者(59例)作为A组,COPD合并CHF患者(63例)作为B组;另选取健康体检正常者(30例)作为C组.采用免疫荧光快速测试法测定受试者血浆BNP水平并分析.结果:血浆BNP水平B组显著高于A组和C组(P＜0.01);而A组显著高于C组(P＜0.01).B组患者治疗后血浆BNP水平明显下降(P＜0.01),治疗后血浆BNP水平B组略高于A组但无显著性差异(P＞0.05).结论:COPD合并CHF时BNP水平明显升高,提示BNP测定对鉴别COPD合并CHF有一定意义,同时可作为COPD合并CHF患者治疗效果的评价指标.     

慢性心力衰竭患者血浆AVP、尿液水通道蛋白2的变化研究(附148例分析)

目的检测慢性心力衰竭(CHF)患者血浆精氨酸加压素(AVP)、尿液水通道蛋白-2(aquaporin-2,AQP2)水平,探讨血浆AVP、尿液AQP2与慢性心力衰竭及低钠血症的关系。方法应用双抗体夹心ELISA法检测148例慢性心力衰竭患者和68例健康对照者的尿液AQP2浓度,用放射免疫分析法同步检测血浆AVP,并测定血钠浓度。结果CHF患者血浆AVP、尿液AQP2的浓度比对照组明显增高(P<0.01),且心力衰竭越重、NYHY等级越高及血钠越低,血浆AVP、尿AQP2的浓度越高。结论AQP2是受血浆AVP调控的靶蛋白,尿液AQP2水平可以反映心力衰竭及低钠血症的严重程度。